Abstract
Background
Emergency Departments (ED) have been identified as high-risk areas for patient related
violence (PRV). The aim of the present study was to analyse recorded events of violence
in a regional Victorian hospital ED, and examine the association these events had
with substance abuse.
Methods
A retrospective cohort study was undertaken to establish the incidence of PRV. Data
were obtained from the hospital's incident management system, RiskMan, over a five
and a half year period for all violent events categorised as Code Grey (CG) and Code
Black (CB). The Haddon Matrix attached to the individual incident record was also
reviewed.
Results
A total of 548 violent events were analysed. The incident rate was 3.4 per 1000 ED
presentations. Intoxication was the primary reason for violent escalations. There
was no association between the frequency of CG events and the day of the week, month
of admission, or shift of the day. Intoxicated men (110, 64.3%) were more likely to
be the instigator of a violent event compared with intoxicated females (61, 35.7%)
(OR 1.5, 95% CI: 1.19–2.02, p < 0.001). A form of restraint, chemical, physical or both, was used in the majority
of violent events (376, 68.6%).
Conclusion
This study demonstrated an increasing frequency of violent events in the regional
ED. Rates of PRV were comparable to those reported in metropolitan hospitals. Intoxication
was the most frequently observed underlying factor for PRV. Regional hospitals are
in need of additional resources to instigate policies and procedures that will maximise
patient and staff safety.
Keywords
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References
- Review article: workplace violence in the emergency department: a systematic review and meta analysis.Emerg Med Aust [Internet]. 2018; 29 ([cited 29.03.18]): 265-275
- Violence in the emergency department: a literature review.Aust Emerg Nurs J [Internet]. 2004; 7 ([cited 05.05.18]): 27-37
- World report on violence and health [Internet]. Geneva.2002 (Available from: http://apps.who.int/iris/bitstream/handle/10665/42495/9241545615_eng.pdf?sequence=1 [cited 10.05.18])
- Patient factors associated with incidents of aggression in a general inpatient setting.J Clin Nurs [Internet]. 2014; 23 ([cited 30.03.18]): 1144-1152
- Incidence and cost of nurse workplace violence perpetrated by hospital patients or patient visitors.J Emerg Nurs [Internet]. 2014; 40: 218-228
- Code Grey Standards. Melbourne.2017
- Review of code grey and code black. Final report, executive summary [Internet]. vol. 61. Melbourne, 2017 (Available from: http://sarpn.org/documents/d0001041/Full%7B_%7DReport.pdf)
- Epidemiology of unarmed threats in the emergency department.Emerg Med Aust [Internet]. 2005; 17: 351-358
- Characteristics of people who assault nurses in clinical practice.Nurs Stand [Internet]. 2007; 21: 35-39
- Gender differences in aggression.Curr Opin Psychol [Internet]. 2018; 19 ([cited 15.04.18]): 39-42
- Violent behavior by emergency department patients with an involuntary hold status.Am J Emerg Med [Internet]. 2017; 36: 392-395
- Estimating prevalence of drug and alcohol presentations to hospital emergency departments in NSW, Australia: impact of hospital consultation liaison services.Public Heal Res Pract Sept [Internet]. 2018; 26 ([cited 04.05.16]): 1-3
- Experiences of emergency department staff: alcohol-related and other violence and aggression.Aust Emerg Nurs J [Internet]. 2011; 14 ([cited 29.03.18]): 9-16
- Rates and features of methamphetamine-related presentations to emergency departments: an integrative literature review.J Clin Nurs [Internet]. 2018; 27: 2569-2582
- Workplace violence in New South Wales emergency departments.Aust Emerg Nurs J [Internet]. 2001; 4 ([cited 02.04.01]): 5-9
- Victorian Auditor General's Report (Australia, May 2015) [Internet].2015 (Available from: http://www.audit.vic.gov.au/publications/20150506-Occ-Violence/20150506-Occ-Violence.pdf [cited 31.03.18])
- National Drug Strategy Household Survey 2016 [Internet]. Canberra.2017 (Available from: https://www.aihw.gov.au/getmedia/15db8c15-7062-4cde-bfa4-3c2079f30af3/21028a.pdf.aspx?inline=true [cited 10.05.18])
- Annual Report 2017 [Internet]. Traralgon.2017 (Available from: https://www.btplc.com/Sharesandperformance/Annualreportandreview/pdf/2017_lobs.pdf)
- Socio-Economic Indexes for Areas (SEIFA) [Internet].Australian Government, Canberra2016 (Available from: http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by Subject/2033.0.55.001∼2016∼Main Features∼Interactive Maps∼7 [cited 21.09.18])
- What is the difference between missing completely at random and missing at random?.Int J Epidemiol [Internet]. 2014; 43 ([cited 21.09.18]): 1336-1339
- Preventing emergency department violence through design.J Emerg Nurs [Internet]. 2018; 44: 7-12
- Correlates of partner and non-partner aggression among patients with substance use disorders in an urban ED.J Subst Use [Internet]. 2013; 18 ([cited 29.03.18]): 262-274
- Increasing workplace violence in an Australian adult emergency department.Emerg Med Aust. 2017; 30: 181-186
- National wastewater drug monitoring program [Internet]. Canberra.2017 (Available from: https://www.acic.gov.au/sites/g/files/net1491/f/national_wastewater_drug_monitoring_program_report_1_0.pdf?v=1490333695 [cited 12.04.18])
- Substance abuse and violence. A review of the literature.Aggress Violent Behav [Internet]. 2003; 8 ([cited 13.04.18]): 155-173
- Drugs of abuse and the elicitation of human aggressive behavior.Addict Behav [Internet]. 2003; 28 ([cited 21.04.18]): 1533-1554
- Patient-related violence against emergency department nurses.Nurs Health Sci. 2010; 12: 268-274
- The incidence, severity and nature of violent incidents in the emergency department.Emerg Med J [Internet]. 1997; 9 ([cited 31.03.18]): 5-9
- Violence & socioeconomic status [Internet].2018 (Available from: http://www.apa.org/pi/ses/resources/publications/factsheet-violence.pdf [cited 19.04.18])
- Needs assessment snapshot. Latrobe local government area.Moe, 2016
- Terminology, stereotypes and aggressive dynamics in the accident and emergency department.Accid Emerg Nurs. 2005; 13: 238-246
- Structured team approach to the agitated patient in the emergency department.Emerg Med Aust [Internet]. 2009; 21 ([cited 30.03.18]): 196-202
- Violence in emergency departments: under-reported, unconstrained, and unconscionable.Med J Aust. 2005; 183: 362-365
- Common quantitative methods.in: Schneider Z. Whitehead D. LoBiondo-Wood G. Haber J. Nursing and midwifery research: methods and appraisal for evidence-based practice. 5th ed. Elesevier, Chatswood, NSW2016: 143-164
Article info
Publication history
Published online: February 15, 2019
Accepted:
January 22,
2019
Received in revised form:
January 22,
2019
Received:
November 10,
2018
Footnotes
☆All work for this research was carried out at the Latrobe Regional Hospital, 10 Village Avenue, 3844 Traralgon, VIC.
Identification
Copyright
© 2019 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.
